Aim: The study objective was to examine the application of excimer laser atherectomy (ELA) in patients with refractory occlusions in femoropopliteal arteries, where the initial conventional percutaneous transluminal angioplasty (PTA) recanalization attempts, were unsuccessful.Methods: The average age of the 40 patients (32 men, 8 women) included in this study was 65.4±9.1 years. The average occlusion length was 17.5 cm (range: 12-25 cm). The initial recanalization attempts were performed with stiff Terumo guidewires (curved or straight) supported by various catheters (straight/multipurpose/Cobra). After the unsuccessful attempt, an excimer laser catheter (catheter diameters from 1.7-2.5 mm) was used for recanalization using the step-by-step method of crossing. After successful crossing, balloon dilatation was performed in all cases. Stent implant was required in 10% (4/40) of procedures. Patients were followed for 12 months with colour-coded Duplex sonography (CCDS).Results: The initial technical success rate of 90% (36/40) resulted in primary, primary-assisted and secondary-assisted patency rates of 58.9%, 67.8% and 83.2%, respectively, after 12 months. No serious complications occurred that were attributable to the intervention.Conclusion: According to these results, ELA recanalization provides a low stent rate alternative to surgical procedures for refractory occlusions. This would offer patients, with increased operative risks, a promising and low-risk therapeutic procedure. The option of a subsequent vascular operation would not be compromised.